Claims Audit Specialist_Quality Assurance

Claims Audit Specialist

Claims Audit Specialist

Who are we?

Versant Health is one of the nation's leading administrators of managed vision care, serving over 35 million of our clients' members across the United States. Our purpose is to make healthy vision a reality for everyone by improving access to care and education in the communities we serve. Fueled by our mission to improve members' lives with easy-to-use vision solutions rooted in choice value, and care, we believe that everyone has the power to become anything they set their sights on.

See how you can make a difference with the support of strong leadership and a team environment.

Versant Health: Making Healthy Vision a Reality for Everyone

What are we looking for?

The Claims Audit Specialist will lead quality reviews of work performed within Operations in accordance with the Departments guidelines. Analyze findings, report results and make suggestions on process improvements where common errors have been identified. Engage in the department or corporate projects in a continuous improvement environment to continually ensure that the work performed in these functional areas is accurate, complete, and improved.

Where you will have an impact

• Responsible for conducting a quality review of functions performed
• Recommend corrections/changes to the systems, policies, and procedures, to ensure a higher quality of work performed
• Provide feedback to associates and management to improve how individuals and departments can improve workflow to eliminate repeated errors
• Assist the department Manager with conducting a routine review of the quality program to ensure it constantly meets business and regulatory requirements
• Provide regular feedback and recommendations to department Manager regarding staff performance and improvement
• Responsible for conducting quality reviews and maintaining documentation as mandated by control activity for SSAE 16 and Financial audits
• Assist in department/corporate projects, as assigned by department Manager/Director, in an effort to ensure that system upgrades, changes in policies, procedures or benefits are introduced into the department accurately and timely
• Other duties as assigned

What's necessary to do the job?

• Preferred Bachelor's degree in related field or equivalent combination of experience and education
• One (1) year of related experience: Quality Review, Quality Assurance, or Process Improvement preferred
• Three (3) years of related experience in Claims required
• Bilingual skills a plus
• Proficiency in Microsoft Office

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.

We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, sex, gender identity, sexual orientation, age, marital status, national origin, ancestry, physical or mental disability or history of disability, genetic information, status as a protected veteran or disabled veteran, or any other status protected by Federal, state or local law.

We offer a comprehensive and competitive total rewards package designed to support your health, financial well?being, and work?life balance. Benefits include medical, dental, and paid vision coverage; paid time off and company holidays; retirement savings with employer contribution; employee wellness resources; and professional development opportunities. Additional benefits may include flexible work arrangements, employee assistance programs, and other programs that support you both at work and beyond.

This role is compensated on a hourly basis. The expected pay is $25 per hour, based on factors such as experience, skills, and role requirements. Actual pay will be determined during the hiring process and in accordance with applicable wage and hour laws.

Versant Health strongly prefers candidates who are able to work hours aligned with the Eastern Time Zone or Central Time Zone. We are unable to consider applicants who do not reside within the continental United States. Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

Essential Responsibilities related to Physical Demands/Work Environment:

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines). Ability and willingness to travel as required.

Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

Our purpose is to make healthy vision a reality for everyone by improving access to care and education in the communities we serve.

Fueled by our mission to improve members' lives with easy-to-use vision solutions rooted in choice, value, and care, Versant Health believes that everyone has the power to become anything they set their sights on.

Our team is guided by core Leadership PrinciplesPerspective, Care, Drive, and Ownershipwhich shape how we work, lead, and grow together.

Our Management Team is committed to fostering a strong and supportive culture, cultivating a thriving work environment, providing clear direction, optimizing resources, enabling innovative solutions, and driving meaningful results.